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My partner who is on MEDs, is undecteable for around 6 months and has a CD4>500 . He likes for me to top him without a condom. He tells me that it is almost impossible for me to become infected this way. When he tops we always use a condom. I have given into him on a couple of occasions but I always feel like a lunatic afterwards for risking my health. I was wondering if it is possible to acutally quantify the risk of me picking up the virus, i.e is it 1/100, 1/1000 etc chance of me becoming infected. I feel if I knew I could make a more informed decision.

Also even when using condoms 100% of the time am I still at risk? and how often should I get tested for HIV?

jeeves hate to say this but condoms isn't 100% effective , but they're highly effective when used properly , but without a condom is alot greater just b/c he's u/d doesn't mean u won't get infected the odds are still there but using a condom is your best bet

Condoms have been proven to prevent hiv infection. There have been three long-term studies of couples where one is positive and one is negative. In the couples who used condoms for anal or vaginal intercourse, but no barrier for oral activities, not one of the negative partners became infected with hiv. Not one.

A correctly used condom rarely breaks - and breakage is the only time a condom won't protect you against hiv. Well, that and when a condom never leaves its wrapper. Read through the condom and lube links in my signature line so you can use condoms correctly and with confidence.

There have been studies of poz/neg partners where the virus was not transmitted to the neg partner when the poz partner had been UD for at least six months and neither had any other active STIs.

HOWEVER, it has to be said that they only looked at straight vaginal barebacking (for the purpose of conception). They have yet to publish findings of any studies looking at poz/neg couples and anal barebacking.

Whether or not you top your partner without a condom is strictly up to both of you. As the insertive partner, your risk is already on the lower side and with his viral load being undetectable, you do stand a very good chance of not becoming infected - provided you use plenty of lube to prevent damage to his anus and rectal lining. He also needs to be 100% sure he doesn't have another STI lurking in there that he doesn't know about.

You really have to decide for yourselves how much risk you two want to take - and ultimately, it is your decision whether or not to take this risk. Don't allow yourself to be pressured into it if you're not comfortable taking that risk. If your partner loves you and isn't just out for ten minutes of raw pleasure, he will respect your decision to use condoms.

And no, there's absolutely no way to quantify your risk. There is a discredited study floating around the internet that is quoted on many websites where they say things like "transmission will result in X out of Y instances", but those numbers were pretty much plucked out of thin air. These numbers were "created" long before we had any studies looking at poz/neg couples and UD VLs so they wouldn't be relevant to your situation anyway.

It's up to you. If you don't want to take any chance of being infected, use condoms. They really do work.

If you are worried about the very small chance of being infected as a top with an undetectable bottoming partner, then stand your ground and don't take the chance.

edited for clarity and to add some details I forgot the first time around

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

There actually are studies that have attempted to quantify the risk of infection.

They are prone to the error that is inherent in these studies since the information is self-reported and it is hard to determine how and from whom someone became infected. So they are not really appropriate for assessing your individualized risk, but more useful for looking at risk across the population level.

Still, it gives you some numbers to work with.

One study from 1999 says that protected insertive anal sex (i.e. a top who used a condom) has a 0.04% risk of infection per act; protected receptive anal sex (i.e. a bottom when a condom is used) has a 0.18% chance.

Another study published in 2010 looked at the risk of unprotected anal sex. That study found that there was a 0.62% probability of infection for an uncircumsized unprotected insertive anal sex partner (i.e. an uncut top who does bareback), and 0.11% for a circumsized insertive partner (i.e. cut top who does bareback).

For the receptive unprotected anal sex partner (i.e. bareback bottom), the probability of infection was 0.65% when the insertive partner pulled out before cumming, and the probability was 1.43% when the insertive partner came inside.

So if you want to rely on the studies, then yes, there is a chance of getting HIV when you top your boyfriend bareback. There is a chance also when you top him with a condom (probably due to condom breaks and slips), though the chances are small. But you want to also think about the fact that having sex with your boyfriend is not a one time thing and that you will be exposing yourself to those small risks repeatedly over time.

brighterside, i agree even though he is undetectable, the v/l is measured is so small that can't be detected but there's always a chance i asked the dr if they're undetectable how can they get reinfected, b/c hiv is still there

Sadly, I have yet to find a study where statistical measurement was not hampered by either the bias of patient report, or the bias of the researchers themselves.

The quoted studies were done using the softest science possible in data collection: Patient report. In ANY scientific data collection, patient report is AT BEST like going to Wikipedia for your information. Oh, it might be there, but you need to check the sources really carefully. In one study, the researchers could not find any statistical evidence of transmission through cunnilingus or insertive oral sex. NEEDING these two items on the list, the researchers (I really believe it was one of Vittinghoff's studies) simply assigned numbers higher than zero to these activities, despite NO evidence of transmission.

That is lazy science, it's bad science, and it illuminates the difficulty in assigning statistical numbers and "odds" to sexual events which differ greatly from person to person, from event to event, from day to day.

I rely far more heavily on serodiscordant relationship studies, since the bias of the researchers plays no role in data collection, and the inherent flaws in patient report are compensated for my the structure of the study itself.

for the poster who feels awful every time he tops his undetectable boyfriend without a condom, I suggest he talk about this with his partner. Regardless of the science (and the science shows over and over that an UD viral load makes anal sex as safe for the insertive partner as a condom,) he should not feel coerced into doing something with which he is uncomfortable.

Then I read that he is also afraid of sex with a condom, so perhaps more evaluation, soul searching is in order for the relationship as a whole.

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"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

Speaking as a LTS who's been in a sero-discordant relationship w/ the same man for the last 20 yrs. I'm POZ and he's NEG

my guess (and this is just a guess) I'm no Doctor or Scientists, nor have I ever been in any sero-discordant studies, butwe don't shoot creampies into each others butts during anal sex... I'm not saying that there is anything wrong with that ( to each his own)

so that would be my assessment as to why my Neg partner has never come down w/ the AIDS, but like I said, that's just my educated guess here....

of course it's a risk, but that is something we both have agreed to as consenting Adults in a sero-discordant LT relationship

I'm not telling anyone how they should have sex, and what they should do, that is something that 2 people have to figure out on there own and whatever is comfortable with the both of you.....

Logged

"it's so nice to be insane, cause no-one ask you to explain" Helen Reddy cc 1974

Speaking as a LTS who's been in a sero-discordant relationship w/ the same man for the last 20 yrs. I'm POZ and he's NEG

my guess (and this is just a guess) I'm no Doctor or Scientists, nor have I ever been in any sero-discordant studies, butwe don't shoot creampies into each others butts during anal sex... I'm not saying that there is anything wrong with that ( to each his own)

so that would be my assessment as to why my Neg partner has never come down w/ the AIDS, but like I said, that's just my educated guess here....

of course it's a risk, but that is something we both have agreed to as consenting Adults in a sero-discordant LT relationship

I'm not telling anyone how they should have sex, and what they should do, that is something that 2 people have to figure out on there own and whatever is comfortable with the both of you.....

God I know Im gonna be shot down for this but what the hell, I'm getting used to it...

Jeeves, don't you think its a little selfish of your partner to insist on you not using condoms when being a top, considering his status? The risk is small but its not zero.

I read this article the other day that being UND lowers the risk of transmission by 96%. So ok...4% of chance of infecting someone. What is the risk of transmitting while using a condom? 0.5%? I know this is all speculation but I don't know, do the math.

God I know Im gonna be shot down for this but what the hell, I'm getting used to it...

Jeeves, don't you think its a little selfish of your partner to insist on you not using condoms when being a top, considering his status? The risk is small but its not zero.

I read this article the other day that being UND lowers the risk of transmission by 96%. So ok...4% of chance of infecting someone. What is the risk of transmitting while using a condom? 0.5%? I know this is all speculation but I don't know, do the math.

You mentioned doing the math - and this is the part where you might feel like you are being shot down.

Sorry. It's not personal.

Thing is, parsing percentage points is immaterial here. This is not about the odds for infection - it is about someone asking someone else to do something sexually with which they are not comfortable, and for which they feel lousy about afterwards.

If the OP was totally into it, and just asking for medical clarification, then the math would be of some, albeit limited use. But the thing is, that doesn't seem to be the case.

Also, statistics are statistical. Plenty of heterosexual couples "bareback" to have babies (and likely afterwards) without infection when the female is positive and the male is negative.

I can see how, for couples who like to mix it up insofar as giving/receiving anal sex, the stats could easily be all over the place. But VL indicators specifically site the bloodstream, which is the primary source of infectious fluid when a positive person bottoms. If the VL is UD, then he chances of infection are close to zero.

Obviously, the variable of not enough lube, rough play, limited foreplay and stuff like that can skew those odds as these things can teat tissue - but again, when we are talking an UD VL, even that is not a significant threat to the top.

However, when both parties are not on the same page from a comfort standpoint, then this is instantly a problem - not insofar as HIV transmission is concerned, but so far as a mutually respectful relationship is concerned.

The math holds true. An UD VL in an anal bottom in a serodiscordant relationship IS comparable to condoms.

But sex that makes you feel lousy and anxious afterwards is never ever cool.

I am in a serodiscordant relationship myself, and trust me, there have been MANY long talks (and lots of research by both of us) about what was and was not on the menu, and under what conditions. Never in my life have I had such a strong impetus to remain faithful to my medical regimen.

But though we are both adults, and he is every bit as smart and as knowledgeable as I am, the kink in the mix is that I love him - and I would not EVER want to feel I coerce him in any way into doing something that brings him anything other than joy. The urge to take care of him is strong, and he feels the same about me.

I figure that getting that far with someone makes everything else just... details.

Logged

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

But though we are both adults, and he is every bit as smart and as knowledgeable as I am, the kink in the mix is that I love him - and I would not EVER want to feel I coerce him in any way into doing something that brings him anything other than joy. The urge to take care of him is strong, and he feels the same about me.

I figure that getting that far with someone makes everything else just... details.

That right there...thats how I feel as well. And that is why I think is selfish to ask someone you care about to do something that might lead to fear and paranoia later. Either in me, the poz, or in him, the neg.

As having having anal sex while being UND...I understand what you said but what about blips? We don't do blood tests every month so theres no way to know if we are UND all day every day. What if theres a blip and we suddenly have a VL of 200? Is it still completely safe?

That right there...thats how I feel as well. And that is why I think is selfish to ask someone you care about to do something that might lead to fear and paranoia later. Either in me, the poz, or in him, the neg.

As having having anal sex while being UND...I understand what you said but what about blips? We don't do blood tests every month so theres no way to know if we are UND all day every day. What if theres a blip and we suddenly have a VL of 200? Is it still completely safe?

Oh, it's never completely safe. And blips do happen. But a consistent UD VL for six months (or more) is as good as you are going to get insofar as unprotected sex is concerned. So far as I know there are no studies with gay men available, though there might be a few underway.

So far, the heterosexual couples trying to conceive have a remarkably good track record. Seeing as how in the scenario I described (the bottom being positive, the top negative) HIV is considerably more difficult to transmit from bottom to top, a 200 or so viral blip will not make that big a difference. But like I also said, it's up to both parties to come to this decision with eyes open, with all the facts, and acknowledging the fact that the risk, though very small, exists.

Again, however, I must reiterate that having the conversation with your partner is NOT selfish. Coercing him/her to do something he/she is uncomfortable with, is absolutely selfish - in the worst sense of the word.

Another solution to condom-free sex, of course, would be to have the negative person prescribed Truvada as PrEP. Best of luck affording it, however.

Logged

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

Oh, it's never completely safe. And blips do happen. But a consistent UD VL for six months (or more) is as good as you are going to get insofar as unprotected sex is concerned. So far as I know there are no studies with gay men available, though there might be a few underway.

So far, the heterosexual couples trying to conceive have a remarkably good track record. Seeing as how in the scenario I described (the bottom being positive, the top negative) HIV is considerably more difficult to transmit from bottom to top, a 200 or so viral blip will not make that big a difference. But like I also said, it's up to both parties to come to this decision with eyes open, with all the facts, and acknowledging the fact that the risk, though very small, exists.

Again, however, I must reiterate that having the conversation with your partner is NOT selfish. Coercing him/her to do something he/she is uncomfortable with, is absolutely selfish - in the worst sense of the word.

Another solution to condom-free sex, of course, would be to have the negative person prescribed Truvada as PrEP. Best of luck affording it, however.

Yes, youre absolutely right, I agree. But going back to what jeeves said, "I always feel like a lunatic afterwards".

Then why is this still going on? Either you are confident in what youre doing or not, that applies to everything in life. Don't go mountain climbing if you don't feel safe enough, you know?

And if his boyfriend knows he is feeling this way why continue to allow it to happen? I know it takes 2 to tango, but some people can be very persuasive and pushy. I still think is selfish, IMO.